Senior Quality Analyst, Claims *Remote*

Providence is one of the nation's leading non-profit healthcare systems with 119,000+ caregivers/employees serving more than 5 million unique patients across 51 hospitals and 800+ clinics. Our locations range from metropolitan centers to rural settings across seven states: Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. As a mission-based, not-for-profit healthcare provider, our commitment to providing compassionate care to all lives on through our five core values: Compassion, Dignity, Justice, Excellence, and Integrity.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Integrity Compliance Audit Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence St Joseph Health operates a self-administered claims program for General and Healthcare Professional Liability, Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims. The Senior Quality Analyst assists the Claims leaders in managing a quality assurance program to ensure compliance with laws and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual learning, data integrity, settlement and excess reporting, payor contracting and other regulatory reporting requirements governing liability claims handling. The candidate selected for this position will be expected to effectively manage multiple priorities at a time, work autonomously in a fast-paced claims environment, and respond positively to change. 

The Senior Quality Analyst performs all duties in a manner that promotes Providence's Mission, values, and philosophy. In all aspects, they serve as a role model for the values and Mission of the organization.

Essential Functions:

• Ensure compliance with applicable laws, insurance regulations, settlement reporting, and other regulatory reporting requirements governing liability claims handling
• Develop and provide training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer reporting, applicable laws, insurance regulations, and other regulations relating to investigating, evaluating, and resolving liability claims. Provide empirically-based input as to training topics
• Act as a resource to fellow caregivers for Medicare Secondary Payer reporting of third-party claim payments and write-offs and serve as our mandatory reporting authorized representative
• Facilitate monthly claims files internal audits including monthly trending analysis reporting from platform analytics, compare as to organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending analysis. Review claim files from a quality assurance perspective to ensure compliance with applicable laws, insurance codes, regulations, and our department’s policies and procedures
• Secure monthly claims data reports and provide quality assurance recommendations to claims leaders for both indicated opportunity areas relative to organizational metrics and KPIs, compliance, best practices as well as broader application potential of high-performance indicators
• Identify and provide feedback to department leaders for claims management improvement opportunities and claims-related trends through audit, data analytics, and training observations
• Recommend improvement opportunities relating to workflow efficiencies and operationalization to department leaders
• Act as a resource and to fellow caregivers regarding applicable federal, state, and local laws, insurance codes, and regulations relating to liability claims handling, including healthcare professional and general liability matters
• Assist department leaders in developing policies and procedures, as requested
• Manage payor contracting requests for claims histories
• Perform claims-related research
• Ensure appropriate reporting of claims to excess liability insurers

Knowledge required for this position include:

• Healthcare professional liability and/or other civil tort claims handling practices 
• Medicare Secondary Payer reporting requirements for third party liability claims
• Reporting to regulatory a